Association between sarcopenic overweight and left ventricular diastolic dysfunction and remodeling in patients with type 2 diabetes.
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ABSTRACT:
SUBMITTER: Zhang YZ
PROVIDER: S-EPMC8654449 | biostudies-literature | 2021 Sep
REPOSITORIES: biostudies-literature
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Association between sarcopenic overweight and left ventricular diastolic dysfunction and remodeling in patients with type 2 diabetes.
Zhang Yong-Ze YZ Huang Ling-Ning LN Shen Xi-Mei XM Lin Jie J Zhao Feng-Ying FY Yan Sun-Jie SJ
Chinese medical journal 20210921 20
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Project description:BackgroundDiabetes has become a global pandemic, posing a sustained threat to human health, primarily due to its associated complications. Left ventricular diastolic dysfunction (LVDD) is a prevalent cardiac complication among patients with diabetes. Since most patients are asymptomatic and lack relevant biomarkers, LVDD has not attracted significant attention from clinicians. The neutrophil-to-lymphocyte ratio (NLR) is a widely studied inflammation biomarker that has been suggested to be linked to various medical conditions, including cardiac diseases. However, its association with LVDD among patients with type 2 diabetes mellitus (T2DM) has not been explored.AimTo clarify the relationship between NLR and LVDD among patients with type 2 diabetes.MethodsWe conducted a cross-sectional study using medical records from 855 patients diagnosed with T2DM who were admitted to the Endocrinology department at Wuhan Union Hospital. According to the ASE/EACVI 2016 recommendations, these patients were categorized into two groups based on sonographic parameters: patients with normal left ventricular diastolic function (the non-LVDD group) and patients with LVDD (the LVDD group). NLR values were calculated and divided into three different levels. Statistical analysis was conducted to evaluate the correlation between NLR levels and the prevalence of LVDD.ResultsThe prevalence of LVDD among hospitalized patients with T2DM in our study was 47.8% (409/855). The mean NLR value of the LVDD group was significantly higher compared with the non-LVDD group [1.60 (1.24-2.05) vs 1.85 (1.44-2.31), P<0.001]. The prevalence of LVDD in the three different NLR levels was 35.51% (76/214), 49.27% (203/412), and 56.77% (130/229), respectively. Unjustified logistic analysis showed that NLR levels were positively associated with the prevalence of LVDD (P <0.001). Compared to the low level of NLR, the unadjusted odds ratios (OR) of LVDD at the medium and high levels were 1.764 (1.255-2.478, P=0.001) and 2.384 (1.626-3.497, P<0.001), respectively (P for trend <0.001).ConclusionOur findings suggest that the NLR is a potential indicator for assisting clinicians in identifying LVDD in patients with T2DM. Patients with elevated NLR levels may be at a greater risk of developing LVDD than those with lower NLR levels, which may require attention and interventions to prevent patients from progressing into heart failure.
| S-EPMC11757108 | biostudies-literature
Project description:AIMS: Diastolic reserve is the ability of left ventricular filling pressures to remain normal with exercise. Impaired diastolic reserve may be an early sign of diabetic cardiomyopathy. We aimed to determine whether diastolic reserve differs in type 2 diabetes (DM) compared with non-DM, and to identify clinical, anthropological, metabolic and resting echocardiographic correlates of impaired diastolic reserve in patients with DM. METHODS AND RESULTS: 237 patients (aged 53±11 years, 133 DM, ejection fraction 68±9%) underwent rest and exercise echocardiography. Mitral E and septal e' were measured at rest, immediately post, and 10 min into recovery. Analysis of covariance (ANCOVA) and binary regression with continuous outcomes were used to model e' and E/e' changes with exercise to identify impaired diastolic reserve defined as post-exercise E/e' ≥15. After adjusting for baseline differences, patients with DM immediately post-exercise had a lower septal e', a lower Δe' (1.2 vs 2.3 cm/s, p=0.006) and a higher Δ septal E/e' (1.7 vs 0.08, p<0.001) than patients without DM. In patients with normal resting E/e' of ≤8 (n=130), DM had a significantly higher post-exercise septal E/e' and a higher Δseptal E/e' (2.63 vs 0.50, p<0.001). E/e' in patients with DM remained significantly elevated up to 10 min post-exercise. Hypertension, longer duration of insulin therapy, poorer glycaemic control, worse renal function, larger left atrial volume and lower septal e' were independent correlates of impaired diastolic reserve in patients with DM. CONCLUSIONS: Patients with DM have impaired diastolic reserve manifest as a blunted e' response with exercise, persisting into recovery. Clinical, anthropometric, metabolic and echocardiographic correlates of impaired diastolic reserve in patients with DM were identified. An impaired LV diastolic reserve may be the underlying pathophysiological mechanism in patients with DM with unexplained exertional dyspnoea and may allow earlier detection of DM cardiomyopathy.
| S-EPMC4395831 | biostudies-other
Project description:BackgroundThe aim of this study was to evaluate the possible presence of diastolic dysfunction and its possible effects in terms of respiratory mechanics, gas exchange and lung recruitability in mechanically ventilated ARDS.MethodsConsecutive patients admitted in intensive care unit (ICU) with ARDS were enrolled. Echocardiographic evaluation was acquired at clinical PEEP level. Lung CT-scan was performed at 5 and 45 cmH2O. In the study, 2 levels of PEEP (5 and 15 cmH2O) were randomly applied.ResultsA total of 30 patients were enrolled with a mean PaO2/FiO2 and a median PEEP of 137 ± 52 and 10 [9-10] cmH2O, respectively. Of those, 9 patients (30%) had a diastolic dysfunction of grade 1, 2 and 3 in 33%, 45% and 22%, respectively, without any difference in gas exchange and respiratory mechanics. The total lung weight was significantly higher in patients with diastolic dysfunction (1669 [1354-1909] versus 1554 [1146-1942] g) but the lung recruitability was similar between groups (33.3 [27.3-41.4] versus 30.6 [20.0-38.8] %). Left ventricular ejection fraction (57 [39-62] versus 60 [57-60]%) and TAPSE (20.0 [17.0-24.0] versus 24.0 [20.0-27.0] mL) were similar between the two groups. The response to changes of PEEP from 5 to 15 cmH2O in terms of oxygenation and respiratory mechanics was not affected by the presence of diastolic dysfunction.ConclusionsARDS patients with left ventricular diastolic dysfunction presented a higher amount of lung edema and worse outcome.
| S-EPMC9604741 | biostudies-literature
Project description:ObjectiveData on cardiac function in patients with nonalcoholic fatty liver disease (NAFLD) are limited and conflicting. We assessed whether NAFLD is associated with abnormalities in cardiac function in patients with type 2 diabetes.Research design and methodsWe studied 50 consecutive type 2 diabetic individuals without a history of ischemic heart disease, hepatic diseases, or excessive alcohol consumption, in whom NAFLD was diagnosed by ultrasonography. A tissue Doppler echocardiography with myocardial strain measurement was performed in all patients.ResultsThirty-two patients (64%) had NAFLD, and when compared with the other 18 patients, age, sex, BMI, waist circumference, hypertension, smoking, diabetes duration, microvascular complication status, and medication use were not significantly different. In addition, the left ventricular (LV) mass and volumes, ejection fraction, systemic vascular resistance, arterial elasticity, and compliance were also not different. NAFLD patients had lower e' (8.2 ± 1.5 vs. 9.9 ± 1.9 cm/s, P < 0.005) tissue velocity, higher E-to-e' ratio (7.90 ± 1.3 vs. 5.59 ± 1.1, P < 0.0001), a higher time constant of isovolumic relaxation (43.1 ± 10.1 vs. 33.2 ± 12.9 ms, P < 0.01), higher LV-end diastolic pressure (EDP) (16.5 ± 1.1 vs. 15.1 ± 1.0 mmHg, P < 0.0001), and higher LV EDP/end diastolic volume (0.20 ± 0.03 vs. 0.18 ± 0.02 mmHg, P < 0.05) than those without steatosis. Among the measurements of LV global longitudinal strain and strain rate, those with NAFLD also had higher E/global longitudinal diastolic strain rate during the early phase of diastole (E/SR(E)). All of these differences remained significant after adjustment for hypertension and other cardiometabolic risk factors.ConclusionsOur data show that in patients with type 2 diabetes and NAFLD, even if the LV morphology and systolic function are preserved, early features of LV diastolic dysfunction may be detected.
| S-EPMC3263884 | biostudies-literature
Project description:Sarcopenia is an aging condition involving low muscle mass and function. Fetuin-A (FetA) appears to be a factor for body composition remodeling. We hypothesized that age increases FetA levels and deteriorates the myocardial function by affecting diastolic function, especially in people with sarcopenia. We enrolled 541 asymptomatic elderly (≥ 65 years) patients. Compared with non-sarcopenic population, FetA levels were significantly elevated in the ninety-two (17%) patients (79 ± 6 years; male: 34.7%) diagnosed with sarcopenia (621.1 ± 140.7 vs. 697.3 ± 179.6 μg/ml, < 0.001). Sarcopenic left ventricular dysfunction (S-LVD) was defined by the coexistence of sarcopenia and systolic impairment (LVEF < 50%) and 23 (4.3%) of them met the criteria. Patients with S-LVD showed relatively reduced systolic heart function, higher end-diastolic pressure and a higher FetA level (all p < 0.001) than did those with sarcopenia but without LV dysfunction (S-NLVD). Conversely, in the group without sarcopenia, FetA levels were similar regardless of systolic function. Multivariable logistic regression showed that older age, impaired diastolic function, and higher FetA levels were significantly associated with S-LVD. In conclusion, we found that FetA was significantly higher in elderly patients with sarcopenia, which was associated with impaired diastolic and systolic functions.
| S-EPMC4498243 | biostudies-other
Project description:BackgroundWe investigated the association between individual components of metabolic syndrome (MetS) and left ventricular (LV) geometric changes, including diastolic dysfunction, in a large cohort of healthy individuals.MethodsOverall, 148 461 adults who underwent echocardiography during a health-screening program were enrolled. Geographic characteristics on echocardiography and several markers of LV relaxation function were identified according to individual MetS components. Univariate linear regression analysis and a multivariate regression model adjusted for factors known to influence LV relaxation function were conducted.ResultsThe prevalence of LV diastolic dysfunction (LVDD) was higher in the MetS group than in the non-MetS group (0.56% vs. 0.27%, p < .001). In univariate and multivariate analyses, E/A ratio, e' velocity, and left atrial volume index were significantly associated with each component of MetS and covariates (all p ≤ .001). In the age- and sex-adjusted model, MetS was significantly associated with LVDD (odds ratio [95% confidence interval], 1.350 [1.103, 1.652]). However, subjects with more MetS components did not have a significantly higher risk of LVDD. As the analysis was stratified by sex, the multivariate regression model showed that MetS was significantly associated with LVDD only in men (1.3 [1.00, 1.68]) with higher risk in more MetS component (p for trend < .001). In particular, triglyceride (TG) and waist circumference (WC) among MetS components were significantly associated with LVDD in men.ConclusionsMetS was associated with the risk of LVDD, especially in men, with a dose-dependent association between an increasing number of components of MetS and LVDD. TG and WC were independent risk factors for LVDD in men.
| S-EPMC9286337 | biostudies-literature
Project description:BackgroundThe level of serum uric acid (SUA) has been reported to be associated with left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD). However, this association remains unclear in patients with chronic kidney disease (CKD).MethodsA total of 1025 patients with pre-dialysis CKD with preserved left ventricular systolic function were enrolled in this cross-sectional study. The LVH and LVDD were assessed using two-dimensional echocardiography and tissue Doppler imaging. The associations of LVH/LVDD with clinical and laboratory variables were investigated using univariable and multivariable logistic regression analyses.ResultsIn a multivariable analysis, the SUA level was an independent predictor of LVH (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.31-1.50, P < 0.001). In addition, patient age, systolic blood pressure, intact parathyroid hormone levels, and left atrial volume index levels were independent predictors of LVH. The SUA level was also an independent predictor of LVDD (OR: 1.93, 95% CI: 1.53-2.43, P < 0.001). Furthermore, systolic blood pressure and left atrial volume index levels were an independent predictor of LVDD. Receiver-operating characteristic curve analysis showed that the best cutoff values of SUA levels for identifying LVH and LVDD were ≥ 7.5 mg/dL and ≥ 6.3 mg/dL, respectively.ConclusionThe SUA level was an independent predictor of LVD and LVDD in patients with CKD, suggesting that SUA could be a biomarker for LVH and LVDD.
| S-EPMC8101764 | biostudies-literature
Project description:BackgroundLeft ventricular (LV) involvement in diabetic cardiomyopathy has been reported; however, only limited data exist on right ventricular (RV) involvement. Therefore, our purpose was to investigate RV systolic dysfunction and its association with LV longitudinal myocardial dysfunction in patients with type 2 diabetes mellitus (T2DM) and preserved LV ejection fraction (LVEF).MethodsWe studied 177 T2DM patients with preserved LVEF and 79 age-, sex-, and LVEF-matched healthy volunteers. LV longitudinal myocardial function was assessed as global longitudinal strain (GLS), and RV systolic function was assessed as RV free-wall strain, and predefined cutoff values for subclinical dysfunction were set at GLS < 18% and RV free-wall strain < 20%, respectively.ResultsRV free-wall strain in T2DM patients was significantly lower than that in normal controls (19.3% ± 4.8% vs. 24.4% ± 5.1%; P < 0.0001). RV free-wall strain in T2DM patients and LV longitudinal dysfunction was similar compared to that in T2DM patients without (19.0 ± 4.5% vs. 19.6 ± 5.0%, P = 0.40). Furthermore, multivariate logistic regression analyses showed that GLS was independently associated with RV systolic dysfunction as well as mitral inflow E and mitral e' annular velocities ratio (odds ratio, 1.16; 95% confidence interval: 1.03-1.31; P < 0.05). Sequential logistic models evaluating the association of RV systolic dysfunction in T2DM patients showed an improvement in clinical variables (χ2 = 6.2) with the addition of conventional echocardiographic parameters (χ2 = 13.4, P < 0.001) and a further improvement with the addition of GLS (χ2 = 20.8, P < 0.001).ConclusionRV subclinical systolic dysfunction was observed in T2DM patients with preserved LVEF and was associated with LV longitudinal myocardial dysfunction. Our findings may provide additional findings for the management of T2DM patients.
| S-EPMC8542339 | biostudies-literature
Project description:PurposeTo assess the impact of left ventricular (LV) diastolic dysfunction on left atrial (LA) phasic volume and function using dual-source CT (DSCT) and to find a viable alternative prognostic parameter of CT for LV diastolic dysfunction through quantitative evaluation of LA phasic volume and function in patients with LV diastolic dysfunction.Materials and methodsSeventy-seven patients were examined using DSCT and Doppler echocardiography on the same day. Reservoir, conduit, and contractile function of LA were evaluated by measuring LA volume (LAV) during different cardiac phases and all parameters were normalized to body surface area (BSA). Patients were divided into four groups (normal, impaired relaxation, pseudonormal, and restrictive LV diastolic filling) according to echocardiographic findings. The LA phasic volume and function in different stages of LV diastolic function was compared using one-way ANOVA analysis. The correlations between indexed volume of LA (LAVi) and diastolic function in different stages of LV were evaluated using Spearman correlation analysis.ResultsLA ejection fraction (LAEF), LA contraction, reservoir, and conduit function in patients in impaired relaxation group were not different from those in the normal group, but they were lower in patients in the pseudonormal and restrictive LV diastolic dysfunction groups (P < 0.05). For LA conduit function, there were no significant differences between the patients in the pseudonormal group and restrictive filling group (P = 0.195). There was a strong correlation between the indexed maximal left atrial volume (LAVmax, r = 0.85, P < 0.001), minimal left atrial volume (LAVmin, r = 0.91, P < 0.001), left atrial volume at the onset of P wave (LAVp, r = 0.84, P < 0.001), and different stages of LV diastolic function. The LAVi increased as the severity of LV diastolic dysfunction increased.ConclusionsLA remodeling takes place in patients with LV diastolic dysfunction. At the same time, LA phasic volume and function parameters evaluated by DSCT indicated the severity of the LV diastolic dysfunction. Quantitative analysis of LA phasic volume and function parameters using DSCT could be a viable alternative prognostic parameter of LV diastolic function.
| S-EPMC4436312 | biostudies-literature
Project description:Circulating thrombospondin-2 (TSP2) levels were associated with the development of heart failure (HF) in recent studies. However, these studies included only a minority of patients with type 2 diabetes, which is associated with an increased HF risk. As hyperglycemia induces TSP2 expression and its tissue expression increases in type 2 diabetes, we investigated the prospective association of circulating TSP2 with incident HF hospitalization (HHF), and its associations with longitudinal changes of echocardiographic parameters in type 2 diabetes. Baseline serum TSP2 levels were measured in 4949 patients with type 2 diabetes to determine its association with incident HHF using multivariable Cox regression analysis. In the echocardiographic study, baseline serum TSP2 levels were measured in another 146 patients with type 2 diabetes but without cardiovascular diseases who underwent detailed transthoracic echocardiography at baseline and after 1 year. Over a median follow-up of 7.8 years, 330 of 4949 patients (6.7%) developed incident HHF. Baseline serum TSP2 levels were independently associated with the development of HHF (HR 1.31, 95%CI 1.06-1.62, p = 0.014) after adjustments for baseline conventional cardiovascular risk factors, atrial fibrillation, estimated glomerular filtration rate, albuminuria and high-sensitivity C-reactive protein level, use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, loop-diuretics, aspirin, insulin, metformin and sodium-glucose co-transporter 2 inhibitors. Moreover, baseline serum TSP2 levels were independently associated with increase in average E/e' and left atrial volume index (p = 0.04 and < 0.01, respectively). Serum TSP2 levels were independently associated with both incident HHF and deterioration in diastolic function in type 2 diabetes. Not Applicable.
| S-EPMC9637303 | biostudies-literature